CPT® Assistant March 2012 gives tons of examples on proper usage of modifier 25 and modifier 59 including with debridement, arthrocentesis, knee pain at a preventive medicine service, and more. Test your skills with this example (“Debridement Guidelines Update”, CPT® Assistant, March 2012, p. 5):

“A patient undergoes debridement of a subcutaneous wound on the left arm measuring 10 sq cm, a subcutaneous wound on the right arm measuring 20 sq cm, and a 10 sq cm wound, including the bone on the left foot.”

“Although located at

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While treating gastroesophageal reflux disease (GERD), your physician may conduct such diagnostic tests as esophageal motility studies to learn the condition prior to a surgical intervention. Read on to know how you can code these tests for optimal results.

Read For Both Manometry and pH Monitoring

The gastroenterologist will most likely choose esophageal manometry if he is trying to assess the patient’s esophagus for neuromuscular disorders. “Esophageal manometry studies are used to evaluate how well the esophagus functions,” says Bridgette Martin, LPN, CPC, CGIC, Coding Specialist-Gastroenterology Associates, Evansville, Indiana. “They may also be ordered to evaluate a patient prior to recommending anti-reflux surgery.” The patient’s documentation will probably show mention of a “manometry nasal catheter” and pressure readings. You report this procedure with 91010 (Esophageal motility [manometric study of the esophagus and/or gastroesophageal junction] study with interpretation and report).

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Medical coders: Be sure to check out the supercharged SuperCoder site. On May 7, the new site opened to rave reviews on its new medical coding tools: CMS, CPT®, and ASA Allowed modifiers, CPT®↔HCPCS, and ICD-10 code search. If you’ve got a coding question, check out the annual coding answer subscriptions and single op report submissions. With prices as low as $3 a question, you’re sure to need a coding answer from SuperCoder’s education experts. Got a code hang up? Find thousands of articles from the 30+ Coding Alerts, now available as single per article purchases. You can even build your own pack. Check out all the new features today!

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When your pulmonologist performs a methacholine provocation challenge test to evaluate the responsiveness of a patient’s airways, he may use spirometry following the testing to see if there is a bronchospastic response. To report these services accurately, you’ll need to know how to report the tests, spirometry and any other E/M services provided during the encounter. Read on to get better grasp on the guidelines that will help you beat methacholine challenge test reporting when your pulmonologist performs them.

Know When to Report Professional and Technical Components Separately

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Question: How should I report the following case for an established patient?

• More than 10 minutes discussing importance of quitting smoking
• Comprehensive history, comprehensive exam, moderate MDM
• ECG and interpretation
• Occasional palpitations, benign HTN, tobacco use, atypical chest pain, COPD.

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The initial preventive physical exam (IPPE) is an important service for every family physician’s office, so be sure to report it appropriately. Know the criteria IPPE visits must meet and when to use G0402, straight from a recent CMS National Provider Call.

Learn the IPPE Basics

“The IPPE is a one-time visit and is covered for beneficiaries within the first 12 months of Medicare Part B enrollment,” says Jamie Hermansen, a health insurance specialist with CMS’s Office of Clinical Standards and Quality/Coverage and Analysis Group. “The IPPE is covered by Medicare Part B.”

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If you think you can ignore the guidelines, you are on the path to wrong arteriovenous shunt intervention reporting. To keep your claims crystal clear, take care to apply these crucial CPT® definitions and rules.

Intervention Comprehension Starts With Anatomy

If you want to ace your arteriovenous (AV) shunt interventions reporting, you have to know that “the AV shunt is artificially divided into two vessel segments,” according to CPT® guidelines. This is important because you calculate the number of interventions based on the number of segments involved rather than the number of lesions.

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Plus: Remember right/left modifiers according to payer policy.

Under ICD-9 rules, you have just one code to report for nosebleeds, whether a patient comes to your office with active bleeding or has nosebleeds so frequently he wants to learn whether something more complex might be happening to cause the problem. Your go-to diagnosis is 784.7 (Epistaxis), which describes all nosebleeds that aren’t caused by a more complex condition.

ICD-10 changes: When the ICD-10 transition takes place, you’ll benefit from a one-to-one crosswalk. Code R04.0 will be your new diagnosis code when reporting nosebleeds.

Documentation:

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There is no way to ethically capture pay for the extra work when your surgeon cuts through adhesions during abdominal surgery. Right?

Wrong! Our experts say you can. Read on to learn the circumstances that warrant additional billing, and the coding methods to capture adhesiolysis pay.

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Keeping track of global-period modifiers can be confusing , but taking the time to learn about the different modifiers and ensuring that you’re using the correct ones in the right situations is key to correct payment. That’s because one modifier restarts the global period, while another does not, thus impacting your reimbursement rates.

The following modifiers have similar definitions, sharing the words “related procedure” and “during the postoperative period”:

• 58 — Staged or related procedure or service by the same physician during the postoperative period
• 78 — Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period.

The similarities leave many coders and billers scratching their heads. Follow our three expert tips to make sure you pick the right modifier every time.

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